Implantation of esophageal cancer onto post-dissection ulcer after gastric endoscopic submucosal dissection

Figure 4 Follow-up esophagogastroduodenoscopy after endoscopic submucosal dissection. A: A follow-up esophagogastroduodenoscopy (EGD) 7 mo after endoscopic submucosal dissection (ESD) showed a slight elevation on the post ESD scar, but biopsy specimens did not show any malignancy; B: Two more months later, EGD showed a submucosal tumor-like lesion with ulceration 15 mm in size, located right under the post ESD scar; C: Magnifying endoscopy with narrow band imaging showed that the base of the elevation was covered with normal mucosa; D: EUS findings indicated that the tumor mainly involved the submucosal layer; E: The tumor was also recognized as well-demarcated, early enhanced mass on CT; F, G: Biopsy specimens from the edge of the ulcer on the top of the elevated lesion revealed moderately differentiated SCC, which resembled the EC (magnification: F × 40, G × 200).